Closing the Gap: Health Insurance as a Lifeline for Indian Mothers and Newborns

Health insurance with maternity benefits in India provides essential financial support for new parents facing escalating healthcare costs. Covering everything from prenatal care and delivery charges to newborn care and IVF procedures, this insurance helps ease the financial burden during crucial stages of parenthood. Although it excludes pre-existing pregnancies and non-medically necessary terminations, maternity insurance offers comprehensive coverage for emergencies like pregnancy-related complications and medically essential abortions.

In India, considering medical inflation, the cost of delivering a baby through regular birth can rise to ₹75,000, while for a C-section, it can go up to ₹2 lakhs. The cost of IVF in India ranges from ₹2-3 lakhs. Moreover, a survey from IIT Madras indicates a spike in C-section deliveries, from 17.2% to 21.5%, over the five years ending in 2021. 

Also, year by year, more people are opting for private hospitals over government-run facilities for delivery due to their advanced infrastructure. With soaring prices and changes in the preferences of new parents, a mediclaim policy acts as a lifeline for mothers and newborns.

Does Health Insurance Cover Maternity Expenses?

No, standard health insurance plans do not cover maternity-related costs. However, insurers offer maternity coverage as an add-on, which you can purchase by paying an additional premium over your base health plan.

What Does Maternity Health Insurance Cover?

Maternity insurance offers peace of mind to new parents by covering the following expenses:

• Pre and Postnatal Expenses: Health insurance with maternity benefits covers both expenses incurred before and after delivery. Prenatal care includes ultrasounds, blood tests, and routine doctor visits. On the other hand, postnatal expenses include vaccinations, follow-up consultations, and medications necessary for recovery. Most insurers cover prenatal expenses before 30 days of delivery and postnatal expenses after 60 days from delivery.
• Delivery Charges: In India, delivery charges for a caesarean section can range from ₹40,000 to ₹2 lakh, depending on the hospital. The maternity package usually includes room rent, labour room charges, surgeon’s fees, anaesthesia, operation theatre costs, and nursing charges. For a normal delivery, the expenses are slightly lower than those for a caesarean. A health insurance plan for a family covers these costs, ensuring that the most joyous moment of your life doesn’t strain your wallet. It is essential to verify with your insurer the maximum coverage and sub-limits applicable to the specific delivery procedure.
• Newborn Baby Cover: Maternity insurance extends coverage to the newborn from day one up to 90 days, or even longer in some cases. This includes hospitalisation costs for any health complications, vaccinations for ailments such as Hepatitis B and polio, NICU admission if required, and treatment for congenital disorders. After this period, a separate individual or floater health plan is required to cover the child. 
• IVF Expenses: IVF, or In-vitro Fertilisation, is a lab-based fertility procedure that requires fertilising an egg with sperm outside the body. The fertilised embryo is then transferred into the woman’s uterus. Most insurers in their maternity cover include IVF, including egg retrieval, ovarian fertilisation, and ovarian stimulation. The policy also covers embryo harvesting and any preimplantation diagnostic tests if recommended by a doctor.
• Pregnancy-Related Complications: A mediclaim policy supplemented by a maternity add-on also includes emergency hospitalisation due to complications like preeclampsia, gestational diabetes, placenta previa, or premature labour. These conditions require immediate medical attention and sometimes surgical procedures. The coverage takes care of hospital stays, doctor fees, diagnostic tests, and medication until the mother is stabilised.
• Coverage for Abortion: Any hospitalisation expenses arising from medically necessary terminations or miscarriages are covered under maternity health insurance. The insurer covers diagnostic procedures, doctor consultations, medications, and surgery (if required). However, for claim processing, it is essential that such procedures are certified by competent medical practitioners. Some common medical conditions for which abortion is covered include ectopic pregnancy, molar pregnancy, or miscarriage due to infections or trauma. It is important to mention that ectopic pregnancy is not covered under the maternity add-on but can be claimed under the base health plan.
• Embryo Freezing: Embryo freezing is the process of preserving fertilised embryos at very low temperatures for future use. It is required during IVF to store extra embryos or delay pregnancy due to medical or personal reasons. Embryos are frozen using a method called vitrification, which prevents ice formation. Later, the frozen embryos can be thawed and implanted into the uterus. Under maternity health cover, the insurer will indemnify the storage expenses related to embryo freezing, with a maximum cap equal to the sum insured.

Key Exclusions of Maternity Health Cover in India

Like any other insurance plan, maternity coverage also has certain exclusions, as detailed below.

• The maternity add-on is available only if the standard plan includes at least one female member who is 18 years of age or older.
• If you are already pregnant at the time of purchasing the policy, maternity expenses related to the same will not be covered. The reason is that the maternity plan comes with a waiting period ranging from 12 to 48 months.
• If you choose to terminate a pregnancy without any medical necessity or doctor’s advice, the expenses related to that abortion will not be reimbursed.
• Any diagnostic tests or scans not recommended by a certified medical practitioner, even during pregnancy, are excluded.
• If you are opting for surrogacy, maternity insurance will not cover any costs incurred for the surrogate mother’s care, delivery, or associated hospitalisation.
• Any congenital (birth-related) defects or abnormalities in your newborn are generally subject to policy exclusion.

Conclusion

Health insurance with maternity benefits alleviates the financial burden on new parents amidst rising healthcare costs. It covers a range of expenses, including prenatal care and delivery charges, as well as newborn care and IVF procedures. Despite certain exclusions, such as pre-existing pregnancies and non-medically necessary terminations, maternity insurance offers comprehensive support during the crucial stages of parenthood.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.